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a6'" SAN JOAQUIN <br />'�''�P�" `` Environmental Health Department <br />(< <br />COUNTY <br />FO Greatness grows ;ref, <br />1 <br />Monitoring Well/Soil Boring Inspection Report <br />Date: h3 I Z Z Inspector: �L1 (6"� CONSTRUCTION <br />Facility Address: L ►n. Lo L(" <br />Well Address:( `w�A <br />WP# A 7 �k A s Well#: <br />Soil Boring#: �L� ' �;Z ' Ck . T�� ftiZr (2,3 <br />Drilling Company: 1+r - <br />Driller Onsite: l r' <br />Consultant: L V(y 5-4 w, i. <br />Geologist: j04C <br />Public Water System Onsite: ❑ Yes 17�'No <br />Domestic Well Onsite: ❑ Yes F1No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method: <br />Verified Chain of Custody: ❑ Yes El No <br />cpn11 , <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes 11 No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth:t� <br />Depth to Water: DI ` <br />Grout Material: I") cx)-',,- k-' <br />Gallons of Grout Used: 1-0 `!>a; <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation <br />,/K Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity r gTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />pallons <br />Cement 94 lb <br />Bags <br />Thickest Th nnest <br />: Bags <br />Thickest Thinnest <br />Bags <br />2.5 5 <br />5 <br />10 <br />1 <br />5 0 <br />10 <br />20 <br />2 <br />7.5 153 <br />15 <br />30 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />1Z5 35 <br />7 <br />35 <br />70 <br />20 40 <br />S <br />1 40 <br />80 <br />E <br />Total Depth: I- ' <br />Drilling Rig Type: Z 5 L'nfi <br />vMin 2" Annulaf �HD' <br />Seal erified: ❑ Yes ❑No <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />rnnnai I`Tinti <br />From <br />From <br />From <br />From <br />❑ Stove Pipe <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height <br />-QW-F <br />ABCVE-GacuNn CrwSTY-aox <br />CCWLETICN CCMPLETICN <br />Ground SLrtac• <br />grout <br />ft. <br />ft. <br />ft. _ <br />N. - <br />^ti. — z <br />= m <br />— a <br />slottedi <br />s*c:on <br />ft. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix <br />Bentonite per 47 Ib 1.411 2.47 <br />Bentonite per 94 Ib 2.821 4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />